Individual
SHANIA GRACE MAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10300 N ILLINOIS ST STE 1100, CARMEL, IN 46290-1167
(317) 944-0980
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
PENDING
IN
363A00000X
Physician Assistant
Primary
10003878A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M6007879793009
DRIVER LICENSE
WI
Enumeration date
12/05/2022
Last updated
01/05/2023
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